Pneumothorax (Collapsed Lung) Treatment in Delhi, India

Pneumothorax, also termed as deflated lung or collapsed lung, is a condition that occurs when there is the presence of air in the pleural space, i.e. the distance between the chest wall and the lungs. As a result, air tends to push on the outer surface of the lung, making it unable to expand causing it to collapse either partially or entirely. It needs immediate medical attention as it can be fatal and life-threatening.

Types of Pneumothorax

There are a few different types of pneumothorax, depending on their cause and impact. These are as follows:

• Traumatic pneumothorax
• Non-traumatic pneumothorax

Other subtypes with either traumatic or non-traumatic causes are:

• Simple
• Tension
• Open

1. Traumatic Pneumothorax: It occurs as a result of some trauma or injury to the chest wall or lung. The trauma can damage chest structures, and the air gets deposited into the pleural space. Immediate management is required for this type as it can lead to cardiac arrest or even respiratory failure.

Following is the list of injuries responsible for causing traumatic pneumothorax:

• Broken ribs.
• Stab wound to the chest cavity.
• Involvement of an individual in a road traffic accident
• Bullet injury to the chest.
• Being at high altitudes .
• Accidental damage in a person because of lung biopsy or CPR.
  
  

1. Non-traumatic Pneumothorax: This type of pneumothorax is often spontaneous because it does not result from trauma. Therefore, it is either primary or secondary. 

Primary spontaneous pneumothorax takes place mainly:

• During pregnancy
• Family history
• Smokers 
• Marfan Syndrome
• Individuals with a tall and thin body

Secondary spontaneous pneumothorax can take place if a person has the following:

• Lung cancer
• Asthma
• COPD, including emphysema and chronic bronchitis
• Cystic fibrosis
• Pulmonary fibrosis
• Collagen vascular disease
• Severe acute respiratory distress syndrome
• Infections like tuberculosis or pneumonia
  
  

1. Simple Pneumothorax: It does not involve the position of other structures.
2. Tension Pneumothorax: It affects the position of other associated structures, like the heart and occurs due to some penetrating injury, rib fracture or blows to the chest.
3. Open Pneumothorax: It occurs when there is a moment of air in and out of an open wound in the chest area.

Symptoms of Pneumothorax

Following are the symptoms of pneumothorax:

• Shortness of breath
• Unilateral chest pain during inspiration
• Cough
• Fatigue
• Tachycardia
• Dyspnoea
• Cyanosis
• Low blood pressure
• Anxiety

Diagnosis of Pneumothorax

In most cases, people with pneumothorax require immediate medical attention and care. First, the doctor will do the chest auscultation and look for related symptoms, family medical history and any previous history of pneumothorax. Apart from this, various other imaging tests are also performed, which are as follows:

• X-ray scans to access the outline of the lung.
• A CT scan comprises a series of X-rays to achieve a detailed lung image.
• Arterial blood gas (ABG) or pulse oximetry measures how much oxygen is in the blood.
• EKG to monitor the functioning of the heart.

Treatment of Pneumothorax

The main aim of treating pneumothorax is based on the re-expansion of the lungs. Treatment options usually depend upon the cause and severity of the problem. Following are the various treatment options available:

• Observation: For minor pneumothorax, the doctor may watch for the functioning of the heart or breathing issues. A follow-up visit accompanies this.
• Supplemental oxygen: The doctor provides extra oxygen if patients present with symptoms and make sure that the patient's condition remains stable.
• Needle aspiration: During aspiration, the doctor uses a syringe to clear some of the air in the pleural space and follows needle aspiration with percutaneous chest tube drainage.
• Chest tube drainage: If the patients have a more significant pneumothorax, the doctor may put a hollow tube in the chest area to reduce the air in the pleural space. As soon as the air pressure decreases, the lung re-expands and heals. Patients may have this tube in place for several days or even longer.
• Chemical pleurodesis: To prevent the lung from collapsing, the doctor may perform pleurodesis, which involves inserting a mildly irritant drug into the pleural space on one side of the chest. The chemicals used are doxycycline, which attaches the lung to the chest cavity, thereby eliminating extra room in the chest cavity.
• Surgery: A person is considered to be a candidate for surgery if: 
• Persistent air leakage from chest tubes.
• Traumatic lung injuries.
•  A lung that does not expand despite chest tube insertion
• Recurrent collapsed lung.
• Pneumothorax in both lungs.
• The patient doesn't respond to any other treatment.
• Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure that uses a small camera to help the surgeon examine the lung and remove the lung tissue accordingly. 
• Lobectomy is a surgical procedure performed to remove one of the lobes of the lung.

Risk Factors of Pneumothorax

Risk factors for a traumatic pneumothorax include:

• Ongoing assisted respiratory care.
• Falls or other types of injury.
• Contact sports, like football or hockey.
• A medical procedure involving the chest or lung area.

The people at highest risk of a non-traumatic pneumothorax comprises:

• Family history.
• Inflammation of small airways.
• History of smoking.
• Asthma or COPD
• The patient is on mechanical ventilation

Complications of Pneumothorax

These may include:

• Pneumohemothorax is a condition where blood enters the chest cavity.
• Respiratory failure.
• Bronchopulmonary fistula.
• Heart attack
• Pulmonary oedema
• Pneumopericardium is a condition where air enters the cardiac cavity.
• Pneumoperitoneum is a condition where air enters the abdomen.

Prevention of Pneumothorax

• Avoid smoking.
• Avoid activities associated with enormous pressure changes.
• Regular follow-up to rule out any lung conditions.

Outlook of Pneumothorax

The long-term outlook for patients with pneumothorax depends on the size and cause of pneumothorax and the treatment received. The majority of the cases are resolved with observation and minimal healing. It takes longer to heal if there are:

• Underlying lung condition.
• Large pneumothorax.
• Secondary spontaneous pneumothorax.
• Injury related pneumothorax.

Review

Reviewed by Dr. Inder Mohan Chugh - Senior Director, Pulmonology.